| NPI | 1174182562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0073379) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13327652-1205) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 13327652-1205) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-02-11 |