NPI | 1083685705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 045878) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CT 045878) |
Enumeration Date | 2006-01-31 |
Last Update Date | 2019-03-19 |