| NPI | 1639565997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A159642) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 20910) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 89141) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 87250) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-02-02 |