| NPI | 1558366856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 48099) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 37736) |
| 2084V0102X Psychiatry & Neurology Vascular Neurology (Licence: KY 37736) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-08-07 |