| NPI | 1639313778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: MO 2013018541) |
| Additional Taxonomies | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: KS 04-38305) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2026-01-08 |