| NPI | 1912101114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 63544) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: SD 10519) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME163534) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 39) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2023-09-01 |