| NPI | 1588184733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 105695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271116) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX 58173) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-08-22 |