| NPI | 1437505203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 218123) |
| Additional Taxonomies | 208VP0000X (Licence: ND LT24453) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2026-07-01 |