| NPI | 1164536553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC 40120) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA G57902) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-10-25 |