| NPI | 1225691777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A178417) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME175344) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX W0711) | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-09-12 |