| NPI | 1245659325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T5268) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD458279) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-07-22 |