| NPI | 1619497161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 81956) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 71046) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX BP10059611) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-08-23 |