| NPI | 1639791031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 6110) |
| Additional Taxonomies | 208VP0000X (Licence: TN 6110) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2025-08-28 |