| NPI | 1114957610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P7369) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 459) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2025-03-31 |