| NPI | 1902892896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 51267) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101236805) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 51267) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2021-01-15 |