NPI | 1215027362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102203302) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO-899) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2020-05-12 |