| NPI | 1013478361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME162824) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 2025-00690) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-07-24 |