| NPI | 1811258130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME162738) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AL MD.35418) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 54466) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2023-09-05 |