| NPI | 1407158108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 52439) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI DO00747) |
| 208600000X Surgery (Licence: CT 52439) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2026-07-16 |