| NPI | 1114998101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD463447) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0055622) |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: PA MD463447) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-09-07 |