| NPI | 1548013915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 323639) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-03235) |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2026-02-15 |