| NPI | 1740542463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 61883) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: AZ 61883) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35129128) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60742150) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2022-04-29 |