| NPI | 1982232898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME160364) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME160364) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2025-11-25 |