| NPI | 1346700903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME164914) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 330122) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-11-22 |