| NPI | 1063774032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084H0002X (Licence: KS 05-39130) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 9407978) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2017-04-07 |