| NPI | 1023171568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101261442) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WV 31208) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX H3349) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX H3349) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2025-04-03 |