| NPI | 1750777041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 95520) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S1822) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2026-05-12 |