| NPI | 1457601031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME140122) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q6165) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PR 019223) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2019-08-07 |