| NPI | 1134642960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101278244) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2021-1184) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: DE C1-0028832) | |
| 207R00000X Internal Medicine (Licence: TX BP10061789) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2026-06-22 |