NPI | 1811302110 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0059992) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 6798) |
Enumeration Date | 2014-06-25 |
Last Update Date | 2022-07-13 |