| NPI | 1922456292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0067172) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A170611) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2021-09-30 |