| NPI | 1780686162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME73301) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME73301) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-08-10 |