| NPI | 1164657383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: TX BP10034903) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: DC MD041433) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX P5724) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2016-04-25 |