| NPI | 1063774669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 10714567-1205) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME166731) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD219186) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61523148) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2024-07-11 |