NPI | 1164405015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301048101) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J2751) |
Enumeration Date | 2005-11-23 |
Last Update Date | 2021-03-26 |