| NPI | 1164432613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 32561) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 32561) |
| 2084S0012X Psychiatry & Neurology, Sleep Medicine (Licence: KY 32561) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2016-04-26 |