| NPI | 1215027487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX J5533) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2005-01520) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: GA 067386) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-09-26 |