| NPI | 1912902099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000036511) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 36659) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: TN MD0000036511) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-05-26 |