NPI | 1023457371 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60982673) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301103168) |
208100000X Physical Medicine & Rehabilitation (Licence: MD D84223) | |
Enumeration Date | 2013-06-20 |
Last Update Date | 2019-11-07 |