| NPI | 1154769933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A139994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125063209) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125063209) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2020-09-08 |