| NPI | 1043508070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T2672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-9294) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M-17549) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD170301) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-11-08 |