| 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 |