| NPI | 1891159232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0063595) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0063595) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-02-23 |