| NPI | 1427442698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X (Licence: CO 0061974) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S2304) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301502661) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 84300) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 61231) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 304855-01) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2026-08-03 |