| NPI | 1164484309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 27427) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 10371257-1205) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2021-07-22 |