| NPI | 1710563879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101289533) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC MD94677) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2026-06-12 |