| NPI | 1083146724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A172954) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101266158) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-03-30 |