| NPI | 1700401866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS20833) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS20833) |
| Enumeration Date | 2020-06-14 |
| Last Update Date | 2025-11-20 |