| NPI | 1750739132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD177596) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ZZ 95838) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2016-11-17 |