NPI | 1457577652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 249755) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101017050) |
Enumeration Date | 2007-04-17 |
Last Update Date | 2014-06-25 |