| NPI | 1124004627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 201902948) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 77053) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 39387) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042-0008294) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2023-02-23 |