NPI | 1174182562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0073379) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 13327652-1205) |
2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 13327652-1205) | |
Enumeration Date | 2019-06-10 |
Last Update Date | 2024-08-06 |