| NPI | 1356448807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 30677) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 30677) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2015-11-10 |