| NPI | 1568031268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 71877) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2021022817) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2026-03-27 |