| NPI | 1174263081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SC LL87816) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL MD.53724) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-06-08 |