| NPI | 1891793402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301075021) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD20194) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 080050) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2026-01-20 |