| NPI | 1942569991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX AT2143) |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital (Licence: TX 2038255) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |