| NPI | 1245726660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME18310) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2022014906) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2026-08-19 |