| NPI | 1962755827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101262079) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME127778) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2025-02-13 |