| NPI | 1023128444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SD 3911) |
| Additional Taxonomies | 174400000X Specialist (Licence: SD 3911) |
| 174400000X Specialist (Licence: MN 41998) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-04-04 |