| NPI | 1902219363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA MD-45304) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: IA R-10017) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-09-07 |