NPI | 1104317262 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A165869) |
Additional Taxonomies | 208600000X Surgery (Licence: AZ R76953) |
Enumeration Date | 2018-05-24 |
Last Update Date | 2024-03-31 |