| NPI | 1619532777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: KS 04-49550) |
| Additional Taxonomies | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: MO 2025032804) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-49550) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2025032804) | |
| Enumeration Date | 2019-05-04 |
| Last Update Date | 2025-08-18 |