NPI | 1992702831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 04-30495) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 30495) |
Enumeration Date | 2005-07-07 |
Last Update Date | 2020-02-05 |