NPI | 1255817086 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 329273) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2019018915) |
Enumeration Date | 2018-07-16 |
Last Update Date | 2022-08-22 |