| NPI | 1417447228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: TX U5347) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U5347) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ R76637) | |
| 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: FL ME154722) | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-02-20 |