| NPI | 1629068713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MA 207879) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 207879) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2025-09-11 |