| NPI | 1679773600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 0436653) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2013017431) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME148868) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2021-0191) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2021-10-25 |