| NPI | 1164680674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101248663) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC resident) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2018-03043) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-01-12 |