| NPI | 1770744112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX P0329) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID MC-0602) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2020003928) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD185800) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 310721) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME134160) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2022-11-29 |