| NPI | 1881787521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME159229) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NE 24888) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2007012300) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-04-28 |