| NPI | 1174967947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO 2017021296) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AR E-12765) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OK 35315) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2022-04-15 |