| NPI | 1154958700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102208541) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101283343) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-12-04 |