| NPI | 1871989152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 67365) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME139800) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-05-18 |