| NPI | 1487270005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-51566) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2025034291) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2025-08-26 |