NPI | 1972560449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA G83706) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 0428328) |
208100000X Physical Medicine & Rehabilitation (Licence: MO 2006028600) | |
Enumeration Date | 2006-04-28 |
Last Update Date | 2007-12-10 |