| NPI | 1891324323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NY 336566) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: DC DO210012370) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-08-25 |