NPI | 1104359058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME162519) |
Additional Taxonomies | 2085N0700X (Licence: FL ME162519) |
Enumeration Date | 2017-04-07 |
Last Update Date | 2025-10-17 |