| NPI | 1710058698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A7576) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 13113) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA DO-07061) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-10-30 |