| NPI | 1790714590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: OK 17648) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: OK 17648) |
| 225400000X Rehabilitation Practitioner (Licence: TX H7901) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX H7901) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2013-12-18 |