| NPI | 1346424686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P1021) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A112940) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX P1021) | |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2020-02-05 |