| NPI | 1689929812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME157404) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 56186) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-39510) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2022-06-16 |