| NPI | 1164633913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2025-01874) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D78555) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 064765) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 2191) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-10-16 |