| NPI | 1891134219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101257393) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D88046) |
| 208D00000X General Practice (Licence: VA 0101257393) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2023-03-03 |