| NPI | 1073860938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: LA 333346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10044550) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 333346) | |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2024-03-12 |