| NPI | 1154420115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NM A-1787-13) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX K0642) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-04-17 |