| NPI | 1104033968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 11643) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-7418) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA 37863) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 55041) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-05-05 |