| NPI | 1679590616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 26809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 26809) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-07-21 |