| NPI | 1265477459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301116605) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX H5281) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MS 15056) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2021-03-31 |