| NPI | 1659512838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 266766) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2013015294) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2013015294) | |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2016-12-08 |