NPI | 1588669360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0059310) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS5890) |
Enumeration Date | 2005-06-17 |
Last Update Date | 2023-01-09 |