| NPI | 1902396559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD213872) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME158259) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ME MD25620) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2023-06-09 |