| NPI | 1699079533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 17418) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN C35169) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 40797-20) | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2023-03-07 |