| NPI | 1043625551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61345144) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 10809968-1205) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-10-18 |