| NPI | 1922186659 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: TN 67975) | 
| Additional Taxonomies | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: CT 045318) | 
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A56469) | |
| Enumeration Date | 2006-11-01 | 
| Last Update Date | 2025-04-16 |