| NPI | 1083173322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 81851) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7738316-1204) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2026-08-04 |