| NPI | 1184006884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ME MD22949) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 68906) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2025-04-30 |