| NPI | 1194161091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A136000) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 21331) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301503230) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T2413) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC MD84958) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2022-03-17 |