| NPI | 1679840862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation Brain Injury Medicine (Licence: PR 19640) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX R0073) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13049I) | |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2018-12-06 |