| NPI | 1578050399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 91655) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS T-3607) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2022-07-01 |