| NPI | 1679692594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 6821) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 5756821-1204) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 244188-1) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-09-04 |