| NPI | 1619968260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 73919) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 81102) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-04-13 |