| NPI | 1841496908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60223832) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 1234567890) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT MED-PHYS-Lic-126990) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2023-06-15 |