| NPI | 1003072646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME158919) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M9832) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-02-27 |