| NPI | 1154696250 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VT 042.0014345) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301109204) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2019-04-22 |