| NPI | 1780644484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 40524) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CO CO-DR-40524) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2021-04-08 |