| NPI | 1013262153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 288595) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD70027315) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 109382) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD227340) | |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2025-09-09 |