NPI | 1417918707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 29233) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX G4829) |
Enumeration Date | 2006-03-28 |
Last Update Date | 2017-12-04 |