| NPI | 1912922881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME130814) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 0500639) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036-116373) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-06-30 |