| NPI | 1083078869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2020-03264) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 12288464-1204) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-10-08 |