NPI | 1992841167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CT 049958) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1855) |
208100000X Physical Medicine & Rehabilitation (Licence: MA 232915) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2015-11-09 |