| NPI | 1215319710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 86603) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 55785) |
| 207R00000X Internal Medicine (Licence: IL 036.152567) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NC 2022-00067) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: IL 036.152567) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-03-12 |