| NPI | 1831177765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 26560) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 35997) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 57555) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 13467) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA MD-44264) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-08-21 |