| NPI | 1730508862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S3805) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 18943) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2019-10-23 |