| NPI | 1861699969 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 30145) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC ll30145) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 90870) | |
| 2084E0001X Psychiatry & Neurology, Epilepsy (Licence: GA 90870) | |
| Enumeration Date | 2007-07-02 | 
| Last Update Date | 2023-10-12 |