| NPI | 1669904850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H88404) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102207082) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2026-05-21 |