| NPI | 1376286872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 0077310) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA DO.OP.70144430) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AK 257261) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A25915) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NV DO4195) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 012666) | |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2026-09-09 |