| NPI | 1861996555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA OS022919) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 34.015381) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102207057) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2024-06-09 |