| NPI | 1992148100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P0301X Physical Medicine & Rehabilitation, Brain Injury Medicine (Licence: VA 0101262042) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101262042) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2023-02-08 |