| NPI | 1003834433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 230181) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 46924) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 46056) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-01-22 |