| NPI | 1689055790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A161313) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA MD-49047) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: IA R-10297) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-01-17 |