| NPI | 1780947937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60720449) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 13524) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID MC-1674) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2026-06-19 |