| NPI | 1205816782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-17311) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA IMLC.MD.61124854) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2025-03-18 |