| NPI | 1639141138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0063832) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 322997-1204) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 41877) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NV DO1602) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 20A11770) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2022-06-07 |