| NPI | 1265054092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06832) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD 06832) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2023-11-07 |