| NPI | 1013210376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0053947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.018898) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2021-12-02 |