| NPI | 1154767630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: TX 1353980) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 39923) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2023-03-24 |