NPI | 1407018666 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD443429) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA08569900) |
Enumeration Date | 2008-06-30 |
Last Update Date | 2020-10-25 |