| NPI | 1972540672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 5315171699) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T6946) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2023-01-25 |