| NPI | 1205838968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101267148) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 2009-01893) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-08-28 |