| NPI | 1043201502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: MA 76360) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 76360) |
| 2084N0600X (Licence: MA 76360) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2025-05-08 |