| NPI | 1972131712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13877410-1205) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 13877410-1205) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2024-06-07 |