| NPI | 1780644054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 273603-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 94-273603-1205) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2026-06-16 |