| NPI | 1972708295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA 20117) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA 002197) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OH 10071) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-10-05 |