| NPI | 1902168438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101267018) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: DE C1-0028889) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301101045) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2026-02-03 |