| NPI | 1649706474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME166630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76287) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T2185) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD218935) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-11-19 |