| NPI | 1255718458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 7149820) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101265103) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2026-03-10 |