| NPI | 1013301340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A15185) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR DO192558) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-11-30 |