NPI | 1134252349 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME119694) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KY 29899) |
Enumeration Date | 2007-03-14 |
Last Update Date | 2019-03-04 |