| NPI | 1366684920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q8019) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09092800) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TX Q8019) | |
| Enumeration Date | 2009-03-29 |
| Last Update Date | 2016-08-10 |