| NPI | 1891965844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME114505) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD33863) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2025-12-01 |