| NPI | 1942616560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: KY 57603) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MA 281354) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME15936) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2024-01-31 |