| NPI | 1619556586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: IA MD-54949) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 71878) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-08-12 |