| NPI | 1851786883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R7037) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: TX R7037) |
| 208100000X Physical Medicine & Rehabilitation (Licence: OH 35.135837) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TX R7037) | |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: OH 35.135837) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX R7037) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2024-02-21 |