| NPI | 1235486440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX q8295) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX Q8295) |
| 283X00000X Rehabilitation Hospital (Licence: TX Q8295) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2021-04-16 |