| NPI | 1164517009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: UT 274745-1205) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WY 8340A) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-11-11 |