| NPI | 1265434112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60987866) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CO 29018) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2026-01-13 |