| NPI | 1982959771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation Brain Injury Medicine (Licence: MN 70248) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101019889) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-06-10 |