| NPI | 1760062640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 011786) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX V5769) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2025-07-10 |