| NPI | 1205280211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD61066458) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75472) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 5315087790) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2026-07-14 |