| NPI | 1457913410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: SC 91688) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 1333445) | |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2024-12-04 |