NPI | 1467890590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A16079) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV DO2315) |
Enumeration Date | 2013-06-11 |
Last Update Date | 2018-08-30 |