| NPI | 1417246786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 82550) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME122400) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2025-10-23 |