| NPI | 1053625459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME134710) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 54629) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301114366) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 19408) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2025-10-28 |