| NPI | 1972946002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME148125) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: MO 2021011899) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: PA MD472072) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: NH 20935) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: MT 90741) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TN 55779) | |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX T4450) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2024-04-05 |