| NPI | 1124039334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 21645) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA MD11448R) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2017-02-15 |