| NPI | 1972065357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX T8363) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T8363) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2024-04-15 |