| NPI | 1124072475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60815280) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 71049) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 32279) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL 27628) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-08-05 |