| NPI | 1922119890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N1934) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA ML20007791) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-08-13 |