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 |