| NPI | 1457713679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S5991) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD70075669) |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2026-02-28 |