| NPI | 1578601019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX H1543) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NM 85-123) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2007-07-08 |