NPI | 1679566434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 78935) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 9108) |
Enumeration Date | 2005-08-26 |
Last Update Date | 2020-03-04 |