| NPI | 1043287733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2007014096) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-23119) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2025-11-20 |