| NPI | 1194806570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301073973) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: MI 4301073973) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-10-03 |