NPI | 1730569419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 74717) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD462364) |
208100000X Physical Medicine & Rehabilitation (Licence: NY 302892) | |
Enumeration Date | 2015-06-08 |
Last Update Date | 2024-10-03 |