| NPI | 1770072753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 93817) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-01322) |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2026-10-05 |