| NPI | 1265428593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 32510) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301084834) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2004032533) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2023-08-30 |