| NPI | 1972958700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 02005415A) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS026206) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2026-10-05 |