| NPI | 1164738910 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA C201158) | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 430 109 7070) | 
| Enumeration Date | 2010-08-30 | 
| Last Update Date | 2025-06-13 |