| NPI | 1073749776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S8383) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: TX S8383) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME118427) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 052613) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2021-12-14 |