| NPI | 1558359943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME109155) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 23234) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01029809) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2022-09-13 |