| NPI | 1215953732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 44235) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 44235) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-06-14 |