| NPI | 1689783342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 017134) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 017034) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2018-04-09 |