| NPI | 1528550043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-11155) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME162945) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-09-19 |