| NPI | 1598961310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX N0278) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 059561) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-03-02 |