| NPI | 1285257162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301513420) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 34716) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IA R-11850) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-09-03 |