| NPI | 1730610346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 2024-00197) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2024-00197) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301507944) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 4301507944) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-03-27 |