| NPI | 1922015643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT CT037501) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 20407) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61015664) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD196718) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-06-18 |