| NPI | 1144421876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2018039152) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX N3935) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-06-01 |