| NPI | 1326454745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: SC 84433) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX R7036) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2026-04-22 |