| NPI | 1376680660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2008-01002) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 72965) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY C2224) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-01-31 |