| NPI | 1285670240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA C167576) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME 70680) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: AZ 42451) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2025-04-11 |