| 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 |