| NPI | 1063975852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101290108) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-02595) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2026-08-14 |