| NPI | 1295850436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX P3560) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P3560) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-12-27 |