| NPI | 1871722520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301116501) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME136530) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD468523) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D78108) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD188151) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NH 19047) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX TM00731) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2023-01-03 |