| NPI | 1306156401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX Q5176) |
| Additional Taxonomies | 2084N0600X (Licence: TX Q5176) |
| 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TX Q5176) | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2024-05-30 |