| NPI | 1588628184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 56201) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0043168) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY 36055) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2018-09-27 |