| NPI | 1700179231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME133261) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD185702) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX TM00742) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.132401) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 296247) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 15031) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 18581) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01077341) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 25602) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301114045) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2026-05-11 |