Individual
PHU LE
Active
Individual
PHU LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
25709
NH
2084N0400X
Neurology Physician
337932
LA
2084N0400X
Neurology Physician
35.141767
OH
2084N0400X
Neurology Physician
Primary
ME168737
FL
208M00000X
Hospitalist Physician
ME168737
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122612900
—
DC
05
—
122612900
—
FL
Enumeration date
04/04/2017
Last updated
09/25/2024
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