NPI | 1497913800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: TX P0097) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P0097) |
Enumeration Date | 2008-06-02 |
Last Update Date | 2023-03-07 |