| 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 |