| NPI | 1245735638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2023022540) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MT 174064) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN 66514) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2026-05-28 |