| NPI | 1891157905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2021011233) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 04-43091) |
| 208D00000X General Practice (Licence: KS 9409082) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-05-06 |