NPI | 1902892904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 19324) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 192745) |
2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2006-00088) | |
Enumeration Date | 2005-09-25 |
Last Update Date | 2023-02-01 |