| NPI | 1922341882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 5101023404) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101023404) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2020-11-11 |