| NPI | 1124111919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2020-03883) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NM MD2005-0833) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-09-28 |