NPI | 1407122542 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 5101019764) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101019764) |
Enumeration Date | 2012-03-22 |
Last Update Date | 2020-11-23 |