| NPI | 1962713081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: MO 2016012572) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: KS 7509) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2016012572) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2016-12-05 |