| NPI | 1558369744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 12583) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 12583) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-01-06 |