| NPI | 1326008384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 010230245) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D0061334) |
| 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: VA 242) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 3089) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-09-29 |