| NPI | 1003274655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 008408) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 64802) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2026-01-21 |