| NPI | 1265826762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 72953) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 19613) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2020-09-01 |