| NPI | 1992164719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T8809) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 59943) |
| 208D00000X General Practice (Licence: NE 30258) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2023-08-18 |