| NPI | 1063494060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 18221) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 018221) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2022-04-01 |