NPI | 1790278026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T7954) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T7954) |
Enumeration Date | 2018-06-12 |
Last Update Date | 2023-06-21 |