NPI | 1053574665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101247609) |
2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: VA 0101247609) | |
Enumeration Date | 2008-07-03 |
Last Update Date | 2024-03-22 |