| NPI | 1841933892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2023043179) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 05-53842) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2026-08-11 |