| NPI | 1689645541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX R1216) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX R1216) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-01-23 |