| NPI | 1699926352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-35499) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2012003462) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2026-06-29 |