| NPI | 1386901072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R7708) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NH 17618) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2022-02-09 |