| NPI | 1104317056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A178055) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ R76690) |
| Enumeration Date | 2018-05-27 |
| Last Update Date | 2023-08-09 |