| NPI | 1023514007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MN 71757) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 71757) |
| 208D00000X General Practice (Licence: MN 71757) | |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-04-03 |