| NPI | 1770967408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO DR.0064226) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.067875) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 61147) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WY 12949A) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2020-08-18 |