| NPI | 1790993590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A117880) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 254024-1) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NV 16168) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: FL TPME1949) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2023-09-06 |