NPI | 1275799769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX S7762) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX S7762) |
208100000X Physical Medicine & Rehabilitation (Licence: TX S7762) | |
Enumeration Date | 2008-08-04 |
Last Update Date | 2025-03-21 |