| NPI | 1790172179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: CA A170719) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: LA 334807) |
| 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: FL ME150139) | |
| 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: LA 334807) | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-09-24 |