| NPI | 1801373089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME170131) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 70880) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35C.001632) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2024-10-30 |