| NPI | 1689785925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: OR DO28084) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OR DO28084) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-12-28 |