| NPI | 1265741698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME151613) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD455946) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2021-08-19 |