NPI | 1982894606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: CA A89407) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL TPME1444) |
2084N0400X Psychiatry & Neurology Neurology (Licence: NV 15658) | |
2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD61024483) | |
Enumeration Date | 2007-07-30 |
Last Update Date | 2024-07-17 |