| NPI | 1578739249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX TX17140) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5101016075) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2022-10-17 |