NPI | 1710548201 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY TP497) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 73389) |
2084N0600X (Licence: KY TP497) | |
Enumeration Date | 2019-06-25 |
Last Update Date | 2025-09-10 |