| NPI | 1134742075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX V0499) |
| Additional Taxonomies | 2084N0600X (Licence: TX V0499) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-04-21 |