| NPI | 1578098554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: HI DOS-2685) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2025-10-02 |