| NPI | 1790798452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q2087) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS013336) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102201750) | |
| 207P00000X Emergency Medicine (Licence: TX BP10045040) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-04-29 |