| NPI | 1700053584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2013-0462) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 81982) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-07-24 |