| NPI | 1134642960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101278244) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10061789) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2024-03-27 |