| NPI | 1063075182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PR 23309) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23309) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2025-04-13 |