| NPI | 1538377205 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 89487) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL 27071) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2009-01588) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.205797) | |
| Enumeration Date | 2007-05-18 | 
| Last Update Date | 2023-07-07 |