| NPI | 1790923449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CO 47493) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10029636) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2015-10-30 |