| NPI | 1699758334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 208817) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60114761) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2021-03132) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2022-11-17 |