| NPI | 1760463830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NV 20169) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G85393) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2024-01-22 |