| NPI | 1518346188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 67949) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-10268) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-08-14 |