NPI | 1285608752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 335350) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 88900) |
208100000X Physical Medicine & Rehabilitation (Licence: KY 31321) | |
Enumeration Date | 2006-02-14 |
Last Update Date | 2023-10-30 |