NPI | 1720342470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL 32599) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106514) |
Enumeration Date | 2012-06-27 |
Last Update Date | 2021-05-05 |