| NPI | 1720041114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ MD9945) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AZ 9945) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 9945) | |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2022-07-21 |