| NPI | 1144179821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 7045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 7045) |
| Enumeration Date | 2026-01-26 |
| Last Update Date | 2026-05-12 |