| NPI | 1932761780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101280837) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NE 8433) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2025-03-13 |