| NPI | 1548842297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX V5516) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: TX V5516) |
| 222Z00000X (Licence: TX V5516) | |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-08-18 |