| NPI | 1922448653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD463752) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 83306-20) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U3790) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301510651) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 76346) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 322579) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2024-02-15 |