| NPI | 1164405080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO CDRH.0000475) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 31739) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2020-0245) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME153964) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2024-02-21 |