| NPI | 1235755471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 1022453) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0100767) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2026-04-10 |