| NPI | 1659686947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S6909) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX BP20049135) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2024-01-19 |