| NPI | 1104005925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME54358) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0054358) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2025-01-30 |