| NPI | 1588084800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 28988) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME176000) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2025042654) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2025-11-11 |