| NPI | 1710565932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A183836) |
| Additional Taxonomies | 2084N0600X (Licence: CA A183836) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2026-04-30 |