NPI | 1639128408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WI 48756) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301093647) |
208100000X Physical Medicine & Rehabilitation (Licence: PA MT188491) | |
208100000X Physical Medicine & Rehabilitation (Licence: PA MD432290) | |
Enumeration Date | 2006-05-09 |
Last Update Date | 2020-05-22 |