| NPI | 1083888069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX T2343) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A112622) |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2026-02-13 |