NPI | 1619111564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A123020) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 000) |
Enumeration Date | 2009-04-22 |
Last Update Date | 2022-02-11 |