NPI | 1205829314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 22162) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 022162) |
Enumeration Date | 2005-08-24 |
Last Update Date | 2018-12-13 |