| NPI | 1679146369 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2025015162) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 38288) | 
| Enumeration Date | 2021-07-20 | 
| Last Update Date | 2025-06-11 |