| NPI | 1821521667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2021-00989) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME164939) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 97793) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35C.001077) | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2024-06-07 |