| NPI | 1891365581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: TX 803479686) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |