| NPI | 1093154072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 57232) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX 575192) |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2020-01-30 |