| NPI | 1992083844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A14053) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q1131) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX BP10039391) | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2021-12-17 |