| NPI | 1124540661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME171619) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-11048) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 332766) | |
| Enumeration Date | 2017-07-15 |
| Last Update Date | 2025-08-05 |