| NPI | 1699106112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX L3804) |
| Additional Taxonomies | 111NR0400X (Licence: TX L3804) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2015-01-13 |