| NPI | 1396327557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 73842) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD.MD.61282272) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2025-08-04 |