| NPI | 1548847080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: UT 14279266-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 72168) |
| 208100000X Physical Medicine & Rehabilitation (Licence: UT 14279266-1205) | |
| 208VP0000X (Licence: MN 72168) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-07-14 |