| NPI | 1932775087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SD 1932775087) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.080793) |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2026-06-26 |