| NPI | 1063858033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R1189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10047461) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2024-09-09 |