| NPI | 1265811541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MT 103373) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: MT 103373) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 010853) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA OP61173686) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2025-10-30 |