| NPI | 1275741779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: TX P4215) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P4215) |
| 2081P0010X Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine (Licence: UT 7604454-1204) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2026-04-22 |