| NPI | 1376962688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R3273) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 79891) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-10-11 |