| NPI | 1225617673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0102232) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS19449) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-05-20 |