| NPI | 1518285782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME123323) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 72118) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2020-08-31 |