| NPI | 1972772044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 43226-020) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M9850) |
| 2084N0600X (Licence: TX M9850) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2026-06-01 |