| NPI | 1235332404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N3043) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 16632) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-02-27 |