| NPI | 1891886297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R7259) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 9400891) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-11-20 |