| NPI | 1811352396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 84709) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD479233) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301506751) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AR E12905) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 316960) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 72421) | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2022-10-05 |