| NPI | 1942588983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME147845) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: IA R-9084) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 57.026702) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 036-154313) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2016-0156) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2025-06-26 |