| NPI | 1164488128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME74877) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME74877) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 101103) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.134822) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2024-12-03 |