| NPI | 1023457454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO.1700) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10050542) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2019-06-06 |