| NPI | 1760972186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME173920) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A179401) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2025-06-20 |