NPI | 1205984457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301045264) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301045264) |
2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MI 4301045264) | |
Enumeration Date | 2007-01-06 |
Last Update Date | 2015-04-30 |