| NPI | 1023640364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 24929) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 24929) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2026-06-01 |