NPI | 1669609160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 7249) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 244801) |
208D00000X General Practice (Licence: ME 2200) | |
Enumeration Date | 2009-06-11 |
Last Update Date | 2021-06-30 |