| NPI | 1134614001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME153563) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M-16858) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-06-13 |