| NPI | 1649561978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 60539) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 1306) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2022-07-21 |