| NPI | 1053675207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: NY 285120) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 70763) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.134980) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2020-05-11 |