| NPI | 1639458805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: SC 39931) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: TN 75084) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301098796) | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2026-08-25 |