| NPI | 1467480376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME130283) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G50462) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N3965) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.151451) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-10-30 |