NPI | 1649352543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301059318) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301059318) |
Enumeration Date | 2006-10-19 |
Last Update Date | 2017-05-26 |