| NPI | 1962541532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4304080912) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 37576) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 055842) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL 17528) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX H8269) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 22110) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 37576-020) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-10-11 |