| NPI | 1336679794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2022-00932) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NC 2022-00932) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2023-01-26 |