| NPI | 1720519184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 64254) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64254) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-03-17 |