| NPI | 1639464431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A136015) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD198490) |
| 282N00000X General Acute Care Hospital (Licence: IA R-916) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL TPME1442) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD61036554) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 17301) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2023-12-27 |