| NPI | 1639664832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VT 042-0016725) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC LL61191) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2023-09-22 |