| NPI | 1013295716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: MA 291171) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: VA 0102203438) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2023-07-31 |