| NPI | 1780119016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MD H92015) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: DC MTL004828) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2023-03-03 |