| NPI | 1235413196 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 50398) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U9264) | 
| Enumeration Date | 2011-10-10 | 
| Last Update Date | 2025-10-13 |