| NPI | 1306227640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: DE C2-0023824) |
| Additional Taxonomies | 208VP0000X (Licence: DE C2-0023824) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2025-09-29 |