| 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 |