| NPI | 1184803330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WV 4641) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102202357) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2025-10-17 |