NPI | 1851603161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 106987) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 57049) |
208100000X Physical Medicine & Rehabilitation (Licence: MI 5101018144) | |
Enumeration Date | 2010-07-02 |
Last Update Date | 2021-06-18 |