| NPI | 1962519066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 21870) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ND 4611) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-07-31 |