| NPI | 1285815605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME158900) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2022049104) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 114802) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2008-0758) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD 00049262) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 37664) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2023-08-30 |