NPI | 1619121324 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME107516) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125053263) |
208D00000X General Practice (Licence: PR 017019) | |
Enumeration Date | 2008-11-07 |
Last Update Date | 2016-12-07 |