| NPI | 1720169915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 371707-1205) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: UT 371707-1205) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-12-20 |