| NPI | 1265417885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 34342) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 30294) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2012-08-13 |