NPI | 1588813711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA 60573972) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 25562) |
Enumeration Date | 2008-09-11 |
Last Update Date | 2019-02-22 |