| NPI | 1659715001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME121861) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: NV 18766) |
| 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: FL ME121861) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NV 18766) | |
| Enumeration Date | 2013-04-28 |
| Last Update Date | 2023-04-06 |