| NPI | 1184696973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: GA 016005) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 16005) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2019-07-15 |