| NPI | 1972899458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PR 022552) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 279736) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-11-22 |