| NPI | 1912325010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 69861) |
| Additional Taxonomies | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: NJ 25MB10611700) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-08-05 |