| NPI | 1578069639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO A166796) |
| Additional Taxonomies | 208VP0000X (Licence: CO A166796) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2025-09-12 |