| NPI | 1689614794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: MN 52487) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 25248) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 52487) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-12-06 |