| NPI | 1477011799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR DO230019) |
| Additional Taxonomies | 208VP0000X (Licence: OR DO230019) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2026-05-22 |