| NPI | 1043261688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX K1266) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX K1266) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX K1266) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-08-22 |