| NPI | 1548908809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP10079478) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2026011401) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2026-07-13 |