| NPI | 1497851042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME93143) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: FL ME93143) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 051777) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2019-02-11 |