| NPI | 1134818669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME162536) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: ZZ 1-97-319-7) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-05-11 |