| NPI | 1700802584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME153265) |
| Additional Taxonomies | 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: KY 52745) |
| 2084N0600X (Licence: VA 0101284533) | |
| 2084N0600X (Licence: KY 52745) | |
| 2084N0600X (Licence: GA 102371) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 52745) | |
| 2084N0600X (Licence: OH 35C.002136) | |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: OH 35C.002136) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2025-10-29 |