| NPI | 1689679714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301119416) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2013-02125) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD00045382) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-02-04 |