| NPI | 1598380909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS21127) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR DO221829) |
| 208D00000X General Practice (Licence: MI 5151014515) | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2025-12-15 |