| NPI | 1902028939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0065957) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MD D0065957) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD D0065957) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-05-20 |