| NPI | 1134656903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TX V0505) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 65292) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX V0505) | |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TN 65292) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2026-02-25 |