| NPI | 1679534853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME115085) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M5820) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35132049) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D0035586) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101038169) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD033604E) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 351302049) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2022-11-16 |