| NPI | 1073574497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N7911) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101238188) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A113912) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-11-10 |