| NPI | 1982684452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301044011) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 30463) |
| 2084N0600X (Licence: MI 4301044011) | |
| 2084N0600X (Licence: MI 927) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-04-29 |