| NPI | 1376577635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200201266) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 96981) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TN MD50027) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2026-08-19 |