| NPI | 1760481626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 86292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036066707) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2025-09-10 |