| NPI | 1861507956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 234294) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 25387) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-03-17 |