| NPI | 1760539555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 30863) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 54534) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S1665) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2026-05-28 |