| NPI | 1821265687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P6606) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD.60264312) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.204258) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2020-12-02 |