| NPI | 1811951064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MI 4301059523) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MI 4301059523) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2021-05-19 |