| NPI | 1952751331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A167962) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SD 12933) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: RI LP03826) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NV 210105) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2023-10-04 |