| NPI | 1821278912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 26580) |
| Additional Taxonomies | 2084N0600X (Licence: WV 26580) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 200319) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2025-10-27 |