| NPI | 1629538947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WI 81637-21) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 67915) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 81637) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-08-07 |