| NPI | 1952046989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD494252) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD494252) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2026-07-29 |