| NPI | 1760206452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL MFC1924) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL MFC1924) |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-11 |