| NPI | 1851304307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN MD0000031053) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 057478) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-08-21 |