| NPI | 1912161431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD442705) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 8301941-1205) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: PA MD442705) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2021-07-21 |