| NPI | 1730173691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME167400) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR 26134) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2025-06-24 |