| NPI | 1720432701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MA 291724) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 291724) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2022-07-07 |