| NPI | 1770503526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME156568) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD213796) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2008-01840) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T9523) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WV 21879) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD460290) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2024-04-05 |