| NPI | 1861435026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME125944) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PR 13734) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-01-03 |