| NPI | 1306808993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4455) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX L9821) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2012-06-22 |