| NPI | 1033603105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 23650) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351040660) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NV 23650) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2023-04-27 |