| NPI | 1548475924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX P6596) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MS 21197) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TX P6596) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2017-05-18 |