| NPI | 1851829618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL AL4517) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL AL4517) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL AL4517) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: FL AL4517) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL AL4517) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |