| NPI | 1235274994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX K4218) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2023-01-04 |