| NPI | 1861029019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0075774) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 12409924-1205) |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 72028) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-10-10 |