| NPI | 1205414711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101275877) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101275877) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-07-11 |