| NPI | 1790172856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX 48043) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX 47365) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 62342) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-07-26 |