| NPI | 1235423393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 16749) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KS 94-07686) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-03-28 |