| NPI | 1033559877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 69184) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 58500) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 58500) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2026-04-28 |