| NPI | 1083068530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2021020615) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KS 0443422) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-09-13 |