| NPI | 1508068750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME166420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01144) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD221500) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301100812) | |
| 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: CA A116552) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2024-10-30 |