| NPI | 1912361031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC MMD.95385MD) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2025-03334) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 65092) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-11-13 |