| NPI | 1598225864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2020017229) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 68742) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2023-06-26 |