| NPI | 1427039411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J4688) |
| Additional Taxonomies | 208VP0000X (Licence: TX J4688) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-09-11 |