| NPI | 1871791038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0067216) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM A-1557-10) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2022-02-15 |