| NPI | 1255424677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 50796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX N4063) |
| 207T00000X Neurological Surgery (Licence: CO DR.0050796) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2019-10-02 |