NPI | 1164925947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 96720) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 300740) |
Enumeration Date | 2018-03-17 |
Last Update Date | 2023-08-11 |