| NPI | 1952780108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME170404) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2022048990) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NY 296834) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2024-09-05 |