NPI | 1316928377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 24065) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2005-01611) |
Enumeration Date | 2005-11-08 |
Last Update Date | 2020-10-08 |