| NPI | 1164050217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-01165) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.079193) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-08-04 |