| NPI | 1033343579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD214578) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME160389) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 45804) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U1591) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2024-04-05 |