| NPI | 1508277856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0064830) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 66278-21) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2021-07-21 |