| NPI | 1265409684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD041310E) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: PA MD041310E) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2025-12-15 |