NPI | 1609840891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 46150) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 6057) |
Enumeration Date | 2006-02-14 |
Last Update Date | 2020-08-21 |