| NPI | 1902265176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 325870) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA OP61038535) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2021-08-10 |