| NPI | 1295155364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A156829) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 20588) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME145224) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 291281) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: CA A156829) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: NY 291281) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-06-20 |