| NPI | 1811488455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2024-01310) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 326381) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME169008) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101282560) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 341425) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2024-09-23 |