| NPI | 1043626401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 65854) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R5749) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2022-06-14 |