| NPI | 1376820514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME171097) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2024048194) |
| 208M00000X Hospitalist (Licence: FL ME171097) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61622830) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 262167) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.152733) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD223124) | |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2025-07-18 |