| NPI | 1134749799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 76632) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ID 8271766) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2026-02-18 |