| NPI | 1780264200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 75753) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MDRE.ML.61291152) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2025-06-19 |