| NPI | 1801479498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 79715) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13521422-1205) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2026-06-23 |