| NPI | 1710253752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 58340) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 66353-20) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MN 58340) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2022-09-28 |