| NPI | 1689954620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: AZ 7148) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2023-11-06 |