| NPI | 1376830513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA MD-45317) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: IA MD-45317) |
| 2084S0010X Psychiatry & Neurology Sports Medicine (Licence: IA MD-45317) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2018-07-18 |