| NPI | 1881252013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 58868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125073740) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125073740) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-08-05 |