| NPI | 1912516790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301512388) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 79401) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-07-21 |