| NPI | 1780900647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 25434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6653) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 67316) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX Q9085) | |
| 208600000X Surgery (Licence: OK 27741) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2022-07-21 |