| NPI | 1144363755 |
|---|---|
| Former Name | LORI M WAGENMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation Brain Injury Medicine (Licence: PA MD427408) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD P17893) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2007-00403) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2016-04-06 |