NPI | 1063653798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 50855) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017995) |
208100000X Physical Medicine & Rehabilitation (Licence: WI 53709-021) | |
Enumeration Date | 2009-03-09 |
Last Update Date | 2022-03-01 |