| NPI | 1790362507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-51416) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2025014851) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2025-07-22 |