| NPI | 1669935375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 1019690) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: MA 1019690) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2024-06-24 |