| NPI | 1548269962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301066617) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301066617) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-10-25 |