| NPI | 1972894095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2023-0521) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 50712) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101272757) | |
| Enumeration Date | 2011-04-23 |
| Last Update Date | 2023-08-21 |