| NPI | 1841727013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AZ 010802) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20249) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2024-01-11 |