| NPI | 1770011272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 69444) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-10903) |
| Enumeration Date | 2017-05-28 |
| Last Update Date | 2023-09-01 |