| NPI | 1972892370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MN 57318) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2015-00822) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NC 2015-00822) | |
| 208D00000X General Practice (Licence: NC 2015-00822) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-05-14 |