| NPI | 1235108986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101023418) |
| Additional Taxonomies | 2084N0600X (Licence: VA 0101023418) |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: VA 0101023418) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2022-06-08 |