| NPI | 1467072710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2024032652) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020019361) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-12-02 |