| NPI | 1922776640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 1354700) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 3127817) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2022-02-15 |