| NPI | 1699398933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 94790) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI LP04930) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-07-23 |