| NPI | 1679886071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 309339) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX Q5733) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TX Q5733) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2018-08-20 |