| NPI | 1568550127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 40721) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA G80499) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX U6548) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-02-19 |