| NPI | 1972769818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: MA 273981) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 273981) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME113090) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 57.012867) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2019-05-03 |