| NPI | 1912353533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2021011023) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 05-47677) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2024-04-08 |