| NPI | 1659488989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD202981) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME64405) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME64405) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-09-23 |