| NPI | 1124540661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: LA 332766) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA R-11048) |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2022-10-21 |