| NPI | 1437598208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME179056) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 69255) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2025-00583) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD488278C) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2026-09-11 |