| NPI | 1720181951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME145025) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NJ 25MA06361300) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD051555L) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 2005-01826) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA G71376) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME145025) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 50578) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-05-18 |