| NPI | 1003621103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: FL 225200000X) |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-02-07 |