| NPI | 1639757123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 54106) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV LL3839) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-06-30 |