| NPI | 1720519184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MN 64254) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64254) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-03-30 |