| NPI | 1659651446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME138557) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 279553) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 279553) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2019-03-28 |