| NPI | 1093035065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME111314) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX N6552) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2012-08-08 |