| NPI | 1881953628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 90850) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 45938) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: GA 90850) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2022-07-15 |