NPI | 1952759607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 78146) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA 20A15762) |
208D00000X General Practice (Licence: CA 20A15762) | |
Enumeration Date | 2016-06-02 |
Last Update Date | 2024-07-10 |