| NPI | 1306160031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 279780) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD209192) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61321471) | |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2025-12-16 |