| NPI | 1649898974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME166143) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.153631) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD20894) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX W0380) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2025-10-28 |