| NPI | 1841784170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 3994) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA RTO000311) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 003597) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-08-08 |