| NPI | 1629258322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OR MD152056) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX P1432) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2017-05-10 |