| NPI | 1639842651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME173872) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE TEP9178) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2025-06-10 |