| NPI | 1538663661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 69074) |
| Additional Taxonomies | 208VP0000X (Licence: AZ 69074) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-11-05 |