NPI | 1639497548 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS016238) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA OS016238) |
Enumeration Date | 2010-05-17 |
Last Update Date | 2020-08-06 |