| NPI | 1205033594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A105629) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX M6924) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2014-04-02 |