| NPI | 1164458659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 78695) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX F8343) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2019-0729) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2024-02-21 |