| NPI | 1790175321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 1024384) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MA 1024384) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 023730) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2025-08-20 |