| NPI | 1679900062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME141165) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 88904) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD472270) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 20899) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61112236) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T4027) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2024-04-05 |