| NPI | 1790278026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T7954) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T7954) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-06-21 |