NPI | 1104849843 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL D0-159) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO159) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2021-02-04 |