| NPI | 1922458843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NE 2441) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA R-10680) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 11730988-1204) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-04-21 |