| NPI | 1891971149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 062676) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10623180) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2008-00384) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2013-02-25 |