| NPI | 1891082293 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA 60752892) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 280806) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL TPME221) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 86502) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IN 01084839A) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2020-03742) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 60792) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 54481) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101269809) | |
| Enumeration Date | 2011-07-06 | 
| Last Update Date | 2022-03-04 |