| NPI | 1194708586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 28288) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 16148) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 17246) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 37266) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-09-08 |