NPI | 1871537563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00021605) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO R4N13) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2019-08-27 |