| NPI | 1417918707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 29233) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX G4829) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2017-12-04 |