| NPI | 1114953650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME110656) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2005030723) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN 47220) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2023-10-11 |