| NPI | 1053307041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TN 35053) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 50021) |
| Enumeration Date | 2005-09-25 |
| Last Update Date | 2007-07-08 |