| NPI | 1942326343 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TN 95) | 
| Additional Taxonomies | 174400000X Specialist (Licence: TN 95) | 
| Enumeration Date | 2007-03-21 | 
| Last Update Date | 2025-05-13 |