| NPI | 1417536590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX W5144) |
| Additional Taxonomies | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: TX W5144) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0075104) | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-05-29 |