| NPI | 1285025650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283X00000X Rehabilitation Hospital (Licence: TX 208800) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 208800) |
| 273Y00000X Rehabilitation Unit (Licence: TX 208800) | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-02-06 |