| NPI | 1659663276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL UO3358) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 15069) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: IL 125063356) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2018-10-03 |