| NPI | 1104273184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A163944) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD230957) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD.70139263) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2026-06-15 |