| NPI | 1205577491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX W4939) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX W4939) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-07-01 |