| NPI | 1790780005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IN 01042880A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 01042880) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: OH 35.057638) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-08-11 |