| NPI | 1134625403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U6304) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 332713) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2023-11-14 |