| NPI | 1669818399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME166668) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2024018440) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 60910) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 58275) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: OR MD219253) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2024-09-16 |