| NPI | 1588654859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MA 40760) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 40760) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2007-07-08 |