| NPI | 1073591517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 54910) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM 2001-302) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2023-02-02 |