| NPI | 1295045326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: UT 7597097-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: UT 7597097-1206) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2019-12-04 |