| NPI | 1609131663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2016031388) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2016031388) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101279248) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-12-06 |