| NPI | 1497281471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME150031) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 111489) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2026-03344) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 29676) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101290045) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD.70143565) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2026-08-04 |