| NPI | 1700291333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME136095) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME136095) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 66291) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-11-05 |