| NPI | 1902366560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME168794) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 11962907-1205) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.151310) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-10-29 |