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 |