| NPI | 1720293285 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: VA 0101238424) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101238424) | 
| Enumeration Date | 2007-05-10 | 
| Last Update Date | 2025-07-11 |