| NPI | 1073194759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101276768) |
| Additional Taxonomies | 2084N0600X (Licence: VA 0101276768) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2026-09-01 |