| NPI | 1417585449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 202401284) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL 21841) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-02-26 |