| NPI | 1861842080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 28101) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MA 12551) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2025-02-18 |