| NPI | 1942474614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101271957) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD.206288) |
| 207R00000X Internal Medicine (Licence: CA A114267) | |
| 207R00000X Internal Medicine (Licence: PA MD458784) | |
| 207R00000X Internal Medicine (Licence: LA MD.206288) | |
| 207T00000X Neurological Surgery (Licence: MI 4301091222) | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2021-07-22 |