| NPI | 1982697876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: TN 54591) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 200301260) |
| 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: GA 79154) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2021-08-10 |