| NPI | 1437779170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME176727) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 35139) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.153918) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A192787) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 85479-20) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-09-09 |