| NPI | 1164405015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301048101) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J2751) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2021-03-26 |