| NPI | 1952938532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 84321) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D98631) |
| 208VP0000X (Licence: WI 84321) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-03-17 |