| NPI | 1871850065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2016-01731) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NC 2016-01731) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2026-06-18 |