| NPI | 1770565640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME137876) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 27666) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MN 34955) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NV 15842) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: WI 63295) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-08-28 |