| NPI | 1710957030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 26860) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 37849) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA MD-31273) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 35985) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-08-20 |