NPI | 1265689095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME162021) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 16059) |
Enumeration Date | 2008-08-22 |
Last Update Date | 2023-07-11 |