| NPI | 1215910096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 13607) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA pending) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2026-07-31 |