| NPI | 1255852422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX U3020) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2017021035) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101272184) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-03-30 |