| NPI | 1750811428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101272773) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MT213344) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-10-02 |