| NPI | 1669891040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME149294) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME149294) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2025-12-21 |