| NPI | 1558655035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD481256) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI MD15771) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2023-07-11 |