| NPI | 1881639581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61394237) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9606) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX K9606) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2025-06-09 |