NPI | 1629258322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD152056) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P1432) |
Enumeration Date | 2007-11-09 |
Last Update Date | 2017-05-10 |