| NPI | 1669405742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 21059020) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 31417) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME88701) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 47442) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2010-07-12 |