| NPI | 1487730628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 65285) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J8053) |
| 208100000X Physical Medicine & Rehabilitation (Licence: IA 38084) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: SD 7369) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-05-27 |