NPI | 1366718546 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 147920) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 61485-20) |
Enumeration Date | 2012-04-01 |
Last Update Date | 2021-11-10 |