| NPI | 1952787954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: ME MD23423) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD23423) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2020-12-18 |