| NPI | 1124674635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ND 22534) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IA 75610) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 75610) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-08-11 |