| NPI | 1811940117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 49266) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX permit#30018731) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-05-13 |