| NPI | 1952857682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 53976) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY R3998) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-05-02 |