| NPI | 1942795802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: PA MT230624) |
| Additional Taxonomies | 2084S0010X Psychiatry & Neurology, Sports Medicine (Licence: FL ME160945) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME160945) | |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2024-12-19 |