| NPI | 1306036785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX N7800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112108) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2020-08-10 |