NPI | 1609064617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.123638) |
Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01064416A) |
Enumeration Date | 2007-10-04 |
Last Update Date | 2020-07-14 |