| NPI | 1700295953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 324404) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX BP10063913) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2021-04-07 |