| NPI | 1780881011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 248684) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TN MD0000046883) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 52524-020) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A110262) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD436076) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA08633200) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-10-06 |