| NPI | 1306410642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 71931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA Mt222970) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 71931) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-06-19 |