NPI | 1609300797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X (Licence: FL ME171952) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX T3968) |
Enumeration Date | 2017-04-14 |
Last Update Date | 2025-04-25 |