| NPI | 1760893069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 56864) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ R74672) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME158475) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2023-01-13 |