| NPI | 1306410642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA MD495749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA Mt222970) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 71931) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 71931) | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-08-24 |