| NPI | 1942888540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 101322851) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101278633) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-08-04 |