NPI | 1639680267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 35422) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT026400) |
Enumeration Date | 2017-10-23 |
Last Update Date | 2025-08-25 |