| NPI | 1225227499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX K1135) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 031554) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-04-14 |