| NPI | 1821360835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC MD042682) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DC 204001) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2016-07-06 |