| NPI | 1477757730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R5771) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: OH OT6189) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2019-06-11 |