| NPI | 1255493011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MD D68800) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0101238222) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: DC MD036944) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2021-07-01 |