NPI | 1528046315 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 200558) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.200558) |
Enumeration Date | 2006-01-03 |
Last Update Date | 2020-01-31 |