| NPI | 1932498342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TX S5507) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301098293) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2020-05-11 |