| NPI | 1881223881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2025036720) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A21127) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-08-26 |