NPI | 1407200520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME159088) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.139690) |
Enumeration Date | 2016-04-14 |
Last Update Date | 2022-12-22 |