| NPI | 1164925947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 96720) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 300740) |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2023-08-11 |