| NPI | 1417450263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101284821) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A175339) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2025-07-23 |