| NPI | 1972560894 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2004-00969)  | 
| Additional Taxonomies | 2084D0003X Psychiatry & Neurology, Diagnostic Neuroimaging (Licence: NC 2004-00969)  | 
| Enumeration Date | 2006-04-26 | 
| Last Update Date | 2023-06-08 |