| NPI | 1053357871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX L9942) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX L9942) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2009-06-17 |