| NPI | 1124589015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME169169) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61567307) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.151219) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD221566) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024034077) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-12-03 |