NPI | 1164795068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A14038) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL UO2698) |
Enumeration Date | 2012-02-23 |
Last Update Date | 2020-04-27 |