| NPI | 1912074162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX S7221) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 234837-1) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 29311) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD436724) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-12-14 |