| NPI | 1649705815 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS21828) | 
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN 4821) | 
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AR E-14563) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL OS21828) | |
| Enumeration Date | 2017-04-25 | 
| Last Update Date | 2025-04-11 |