| NPI | 1699721746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 12356) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 37296) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-07-26 |