| NPI | 1063413482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX L3943) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX L3943) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-03-12 |