| NPI | 1073501219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD202075) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 217691) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D50946) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2012-0560) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2012-08-19 |