| NPI | 1033679964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 81157) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX U9874) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-08-26 |