| NPI | 1710954359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 9701712) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 36162) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2023-12-01 |