| NPI | 1366066698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX W0585) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 29327) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2026-05-19 |