| NPI | 1790878148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101246363) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0101246363) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2014-05-06 |