| NPI | 1962488692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0043243) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MD D0043243) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2017-03-31 |