| NPI | 1942425574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 50134) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WY 18672A) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2025-09-09 |