| NPI | 1851421838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0101265945) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 134921) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 31853) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2019-09-11 |