| NPI | 1386272136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL 43491) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NJ 25MA12125100) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2025-09-02 |