| NPI | 1558625921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX R2855) |
| Additional Taxonomies | 2084N0600X (Licence: TX R2855) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2025-11-05 |