NPI | 1336534668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A168814) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA10641100) |
208100000X Physical Medicine & Rehabilitation (Licence: NY 298443) | |
Enumeration Date | 2015-04-02 |
Last Update Date | 2020-08-18 |