| NPI | 1831746502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX U9045) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101286003) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2025-07-30 |